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1.
World J Clin Cases ; 7(21): 3419-3435, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31750326

RESUMO

BACKGROUND: The incidence of proximal gastric cancer (GC) is increasing, and methods for the prediction of the long-term survival of proximal GC patients have not been well established. AIM: To develop nomograms for the prediction of long-term survival among proximal GC patients. METHODS: Between January 2007 and June 2013, we prospectively collected and retrospectively analyzed the medical records of 746 patients with proximal GC, who were divided into a training set (n = 560, 75%) and a validation set (n = 186, 25%). A Cox regression analysis was used to identify the preoperative and postoperative risk factors for overall survival (OS). RESULTS: Among the 746 patients examined, the 3- and 5-year OS rates were 66.1% and 58.4%, respectively. In the training set, preoperative T stage (cT), N stage (cN), CA19-9, tumor size, ASA core, and 3- to 6-mo weight loss were incorporated into the preoperative nomogram to predict the OS. In addition to these variables, lymphatic vascular infiltration (LVI), postoperative tumor size, T stage, N stage, blood transfusions, and complications were incorporated into the postoperative nomogram. All calibration curves used to determine the OS probability fit well. In the training set, the preoperative nomogram achieved a C-index of 0.751 [95% confidence interval (CI): 0.732-0.770] in predicting OS and accurately stratified the patients into four prognostic subgroups (5-year OS rates: 86.8%, 73.0%, 43.72%, and 20.9%, P < 0.001). The postoperative nomogram had a C-index of 0.758 in predicting OS and accurately stratified the patients into four prognostic subgroups (5-year OS rates: 82.6%, 74.3%, 45.9%, and 18.9%, P < 0.001). CONCLUSION: The nomograms accurately predicted the pre- and postoperative long-term survival of proximal GC patients.

2.
Asian J Surg ; 42(9): 853-862, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30704964

RESUMO

To identify the risk factors for intraoperative laparoscopic hemostasis during laparoscopic spleen-preserving splenic hilar lymph node dissection (LSPSD) for proximal gastric cancer (GC) and to develop and validate a model to estimate the risk of intraoperative laparoscopic hemostasis. Between January 2011 and December 2014, we prospectively collected and retrospectively analyzed the medical records of 398 patients with proximal GC who underwent LSPSD. The data were split 75/25, with one group used for model development and the other for validation testing. Of the 398 patients enrolled in this study, 174 (43.7%) required laparoscopic hemostasis treatment. A multivariate analysis determined that the risk factors for the model group were gender, preoperative N stage, and terminal branches of the splenic artery (SpA), and each factor contributed 1 point to the risk score. The intraoperative laparoscopic hemostasis rates were 11.5%, 33.6%, 58.5%, and 73.5% for the low-, intermediate-, high-, and extremely high-risk categories, respectively (p < 0.001). Blood loss volume (BLV) and operative time (in min) for LSPSD increased significantly (p < 0.001) as the risk increased. The area under the receiver operating characteristic curve for the intraoperative laparoscopic hemostasis score was 0.700. The observed and predicted incidence rates were parallel for intraoperative laparoscopic hemostasis in the validation set. This simple, efficient scoring system using the factors for gender, preoperative N stage, and terminal SpA branches can accurately predict the risk of intraoperative laparoscopic hemostasis during LSPSD to improve surgical safety.


Assuntos
Hemostase Endoscópica/estatística & dados numéricos , Cuidados Intraoperatórios/estatística & dados numéricos , Laparoscopia/métodos , Excisão de Linfonodo/métodos , Tratamentos com Preservação do Órgão/métodos , Baço , Neoplasias Gástricas/cirurgia , Idoso , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Artéria Esplênica
3.
Oncotarget ; 8(45): 80050-80060, 2017 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-29108387

RESUMO

Purpose: To investigate upper stomach carcinoma risk factors for No. 10 lymph node (LN) metastasis, and establish a preoperative scoring system to predict No.10 LN metastasis. Method: Between January 2011 and December 2014, we prospectively collected and retrospectively analyzed the data of 398 patients with upper-third gastric cancer (GC) who underwent laparoscopic spleen-preserving hilar lymph-node dissection (SHLND). We use the logistics regression analysis risk factors of No. 10 LN metastasis to establish and verify a scoring model. Result: Among the 398 patients examined, 38 patients had No. 10 LN metastasis, yielding a 9.6% transfer rate. The preoperative risk factor analysis for No. 10 LN metastasis in the modeling group showed that tumor size, preoperative T staging, and preoperative N staging are independent risk factors. To establish a scoring system, we divided the modeling group of patients into three levels: low risk, intermediate risk, and high risk. The No. 10 LN metastasis rates of the low risk, intermediate risk and high risk groups were 2.84%, 13.9% and 34.9% respectively, with statistically significant (P < 0.001). The value for the area under the ROC curve of the scoring system was 0.820, and there were no statistically significant differences between the observed and predicted incidence rates for No. 10 LN metastasis in the validation set (P > 0.05). Conclusion: The scoring system comprising the tumor size, preoperative T stage and N stage is a simple and effective method to predict the risk of No. 10 LN metastasis and to preoperatively select cases suitable for laparoscopic spleen-preserving SHLND.

4.
World J Gastrointest Surg ; 8(6): 402-6, 2016 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-27358672

RESUMO

For advanced proximal gastric cancer (GC), splenic hilar (No. 10) lymph nodes (LN) are crucial links in lymphatic drainage. According to the 14(th) edition of the Japanese GC treatment guidelines, a D2 lymphadenectomy is the standard surgery for advanced GC, and No. 10 LN should be dissected for advanced proximal GC. In recent years, the preservation of organ function and the use of minimally invasive technology are being accepted by an increasing number of clinicians. Laparoscopic spleen-preserving splenic hilar LN dissection has become more accepted and is gradually being used in operations. However, because of the complexity of splenic hilar anatomy, mastering the strategies for laparoscopic spleen-preserving splenic hilar LN dissection is critical for successfully completing the operation.

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